from https://my.clevelandclinic.org/health/diseases/24787-grief

Grief

Grief involves coping with loss. Death, divorce and the loss of a home are all major events that people grieve. While everyone’s experience of grief is different, there are common responses that can be useful to recognize if you’re facing a loss. Whether grieving or supporting a loved one, practice patience as you work through this difficult time.ContentsOverview Symptoms and Causes Outlook / Prognosis Living With Additional Common Questions

ContentsOverview Symptoms and Causes Outlook / Prognosis Living With Additional Common Questions

Overview

What is grief?

Grief is the experience of coping with loss. Most of us think of grief as happening in the painful period following the death of a loved one. But grief can accompany any event that disrupts or challenges our sense of normalcy or ourselves. This includes the loss of connections that define us.

You may grieve the loss of:

A friend, family member, partner or pet.
A marriage, friendship or another form of kinship.
Your home, neighborhood or community.
Your job or career.
Financial stability.
A dream or goal.
Good health.
Your youth.
Fertility.

You may also grieve your own loss of life as you prepare for death. For instance, people diagnosed with terminal illnesses often grieve no longer having the time to experience or achieve things they would’ve liked to.

Stages of grief

Elizabeth Kubler-Ross describes the five stages of grief in her book On Death and Dying. Although it was published in 1969, it’s still the most well-known resource for understanding the grieving process. For her book, Kubler-Ross interviewed over 200 people with terminal illnesses. Through these conversations, she identified five common stages people experience as they grapple with the realities of impending death.

Although Kubler-Ross’s work focuses on grief responses from people who are dying, many use these stages to understand grief across multiple types of loss. Stages include:

Denial. You may have difficulty accepting that a loss is real.
Anger. You may direct anger at multiple sources, including people who couldn’t save a loved one, God, yourself — or even no one in particular.
Bargaining. You may imagine reaching an agreement, so you don’t have to deal with a loss. You may also regret past actions that you imagine could’ve spared you from loss.
Depression. You may experience the complex emotions associated with depression, including emotional detachment.
Acceptance. Eventually, most people embrace the reality of loss even if the pain’s still there.

Many people reduce these stages to linear steps everyone must experience to grieve. But the stages aren’t (and were never intended to be) rules. Not everyone who grieves experiences these stages, and they don’t have to happen in any particular order.

What are some types of grief?

There are multiple ways to experience grief. Different types of grief describe how varied and complex grief can be.

Anticipatory grief

Anticipatory grief involves grieving before the actual loss. For example, you may begin grieving when you learn that you or a loved one has a terminal illness. Processing grief beforehand can prepare you to face the loss when the time comes. Still, it’s important not to allow grieving to distract you from enjoying the precious time you do have.

Abbreviated grief

Sometimes, you’re able to move through the grieving process quickly. This is the case with abbreviated grief. Abbreviated grief may follow anticipatory grief. You can grieve a loss quickly because you’ve already done a lot of emotional labor while anticipating that loss. Grieving for a short time doesn’t mean you never truly cared about what you lost. When it comes to grief, we’re all on different timelines.

Delayed grief

Instead of experiencing the emotions that accompany grief immediately after a loss, you feel them days, weeks or even months later. In some instances, the shock of the loss pauses your body’s ability to work through these emotions. Or you may be so busy handling the practical matters that accompany loss (like funerals and wills) that your body can’t grieve until you’ve handled these responsibilities.

Inhibited grief

Inhibited grief involves repressing emotions. Most of us haven’t been taught how to process — or even how to recognize — the confusing emotions that can arise when we’re grieving. As a result, many people who repress their emotions don’t realize they’re doing so. Unfortunately, when you don’t allow yourself to pause and feel these emotions, grief often shows up as physical symptoms like an upset stomach, insomnia, anxiety or even panic attacks.

Cumulative grief

With cumulative grief, you’re working through multiple losses at once. For example, you’re not only grieving the loss of a child. You’re grieving the ending of a marriage that followed that loss. Grieving multiple losses simultaneously makes the process difficult and complex in unexpected ways.

Collective grief

Most of us think of grief as personal, but collectives (groups) grieve, too. Major events like wars, natural disasters, school shootings and pandemics create far-reaching losses. They change what counts as “normal” life. As a group, we grieve the shared experiences we’ve lost as we struggle to imagine a changed future.

Symptoms and Causes

What are the symptoms of grief?

Grief can affect every aspect of your being — your mind, body and spirit.

Emotional symptoms

People who are grieving often describe emotions as “coming in waves.” It may feel as if emotions wash over you without warning. One minute, life may feel as if it were back to normal, and the next, you may find yourself in tears. Grief causes people to experience the entire spectrum of emotions — from sadness to anger to joy. You may sometimes feel detached from your emotions and operate as if you were on autopilot.

You may experience confusing and conflicting emotions, too, such as:

Sadness that a loved one’s gone but relief that they’re at peace.
Yearning for a spouse after a divorce but also excitement that you get another shot at love.
Guilt for feeling grateful that you no longer have to provide exhausting around-the-clock care for a dying relative.
Competing feelings of apathy, anger, sadness and regret as you grieve the loss of a friend or family member with whom you had a strained or hostile relationship.

There are no right or wrong emotions when it comes to grief. It’s essential to acknowledge and feel them to heal.

Physical symptoms

Loss is an extreme stressor that can take a major physical toll on your body. Grief can overwork your nervous system. It can cause a weakened immune system that makes it easier for you to get sick.

Symptoms include:

Fatigue.
Headaches.
Nausea.
Restlessness.
Upset stomach.
Heart palpitations.
Weak muscles or joint pain.
Tightness in your chest or throat.
Having reduced or increased appetite.
Trouble sleeping (insomnia) or sleeping too much.

Behavioral changes

Grief can make it hard to concentrate or complete tasks. Symptoms include:

Confusion.
Trouble thinking or making decisions.
Feeling as if you’ve lost a sense of hope or direction.
Difficulty focusing on anything other than your loss.
Difficulty remembering or keeping track of your responsibilities.

Complications of grief

In real-time, all grief is complex. In certain circumstances; however, grief can evolve into something even more complex — complicated or prolonged grief. Complicated or prolonged grief often involves especially challenging circumstances or extreme symptoms that interfere with daily life over a long period.

Complicated grief can stem from any of the types of grief. It can be made even more difficult by things like:

Absent grief.When you don’t show any outward signs of grief. Sometimes, you may not exhibit signs of grief because you’re frozen in denial. Other times, a person who may not appear to be grieving is privately working through complex emotions others can’t see.
Ambiguous loss. When there’s a lack of closure around a loss. For example, it may be especially difficult to move through grief when a loved one is presumed dead, but their body isn’t found. Ambiguous loss also includes grieving a loved one who’s still alive but feels out of reach (as with someone incarcerated or deported). You may grieve changes that create psychological distance from a loved one, as with dementiaor Alzheimer’s disease.
Disenfranchised grief. When society doesn’t consider a loss worthy of grief. Grieving can feel especially isolating when others signal that your grief isn’t valid. Examples include the death of a pet or the loss of a same-sex partner. Disenfranchised grief also involves deaths that society considers taboo, like deaths from suicide or drug overdose.
Traumatic grief. When you’re processing a loss and trauma at the same time. Traumatic grief involves losses that happen under horrific, unpredictable circumstances. Natural disasters, accidents and violent deaths can all lead to trauma or even post-traumatic stress disorder (PTSD) that you’ll need to process and seek treatment for alongside grief.

Grief can be considered complicated or prolonged when even a year after the loss you:

Feel as if a part of yourself is lost or has died.
Don’t believe that the death or loss has occurred.
Avoid reminders of the death or loss.
Experience intense emotional pain relating to the loss that interferes with daily living.
Feel emotionally numb, lonely or as if your life doesn’t have meaning or purpose.
Find it difficult to live life, make plans with friends, participate in activities you enjoy or make decisions for the future.

Outlook / Prognosis

How long does grief last?

The American Psychological Association (APA) defines grief as lasting from six months to two years. Symptoms gradually improve as time passes.

It’s important to remember that grief doesn’t fit into neat boxes or timelines. Everyone’s grief and grieving timelines are different. Also, there’s never a time when you’re “done” with grief. Your connection with a loved one who’s passed, a dissolved marriage, an abandoned dream, etc., becomes integrated into your ongoing life story. It’s forever a part of who you are.

Still, if you’re having trouble coping with loss, especially if it’s interfering with your ability to live your life, reach out to a grief counselor or therapist.

Living With

How can I cope with grief?

Coping with grief takes time and patience. But there are things you can do to make coping easier on yourself and others who may need your support.

Taking care of yourself

Practice self-care.Taking care of your mind and body is essential when you’re grieving. Prioritize getting seven to eight hours of sleep each night, and take a nap if you need to recharge. Exercise and eat regular, nutritious meals. Meditate or practice yoga. Take bubble baths. Make caring for yourself a priority as you grieve, and don’t feel guilty about it.
Stick to a routine. Grief interrupts your sense of normalcy, disrupting your emotions in the process. Sticking to a routine is a good way to regain a sense of control and regulate your emotions. Go to bed and wake up at consistent times. Try to eat meals at the same time each day. Shower. Tally each task you complete as a win.
Attend to your emotions. Resist the urge to distract yourself from difficult emotions by getting lost in work or hobbies. Grieving requires dealing with painful emotions. Don’t be ashamed to cry. Allow yourself to remember moments you shared with a loved one who’s no longer in your life. Move your grief outward by expressing your feelings in ways that make sense to you. For example, journaling, telling stories about your loved one or singing a song that reminds you of them are all ways to process difficult emotions.
Reach out to others. One of the best ways to deal with loss is to remind yourself of the connections you still have. It’s OK to need alone time when you’re grieving, but don’t isolate yourself. Remind yourself that not everything has changed — even if it feels like it. There are people in your life who love you and want to support you.
Speak to a therapist or grief counselor. Sometimes, working through grief requires professional help. If grief is interfering with your ability to live your life or if your symptoms haven’t improved after six months, it may be time to reach out to a professional.

Supporting a loved one who’s grieving

Be present. Make yourself available based on your loved one’s needs. No one — including your friend or family member who’s grieving — expects you to be a grief expert or say the exact right thing. Being there for them is enough. Ask them about their needs. Do they need to talk? A distraction? Help with making funeral arrangements? Support them in the ways they need.
Offer to help. Not everyone feels comfortable asking for help, even when they need it. Pay attention to ways you can assist and volunteer to help. Can you drive the kids to school? Help with the laundry? Cook or provide grocery gift cards to help keep everyone fed?
Signal that you’re open to talking. Pay attention to your loved one’s cues about whether they’d like to talk about their loss. For example, you may feel it’s awkward or insensitive to mention the name of a loved one who’s passed. Often, however, the person who’s grieving is waiting for a signal that it’s OK to share stories and process their feelings with others. If they do open up, listen more than you talk.
Don’t minimize someone’s loss. Take care not to communicate that someone’s loss wasn’t a big deal or that they should’ve moved on already. And don’t put a positive spin on loss either. Statements like “it’s all for the best” or “they’re in a better place now” may be well-intentioned, but they can sound dismissive to a person who’s grieving. Instead of reaching for silver linings, allow your loved one to process their feelings honestly. It’s a natural and necessary part of grieving.

Additional Common Questions

What is the difference between grief and grieving?

Grieving is the process of working through grief. Providers who help people cope with grief use words like “working” or “moving” through grief to highlight the demands grief places on us.

What is the difference between grief and bereavement?

Bereavement is the grieving period that follows death. It often involves grieving the absence of a loved one privately and mourning the loss alongside others.

What is the difference between grief and mourning?

Mourning describes how we express grief outwardly. You may mourn a loved one by sharing stories about them, planting their favorite flower in your garden or spreading their ashes in their favorite vacation spot. Funerals and celebration of life ceremonies exist so people who are grieving can mourn in the company of others who care.

A note from Cleveland Clinic

Everyone’s experience of grief is unique. But recognizing feelings, thoughts and behaviors that may surface during this time can provide assurance that you’re not alone. You — like many others — will get through this. It’s a common (but true) saying that the only way out of grief is through. Working through difficult emotions can give you the strength you need to move forward in your life while continuing to hold a place in your heart for the loved ones and life experiences you’ve lost.

Grief: Stages and Coping